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Aerosolized Colistin Cost-effectivenessAerosolized Colistin Cost-effectiveness FREE TO VIEW

Pavlos M. Myrianthefs, MD, PhD; George J. Baltopoulos, MD, PhD
Author and Funding Information

From the Department of Critical Care, Athens University, Intensive Care Unit, Agioi Anargyroi Hospital.

Correspondence to: Pavlos M. Myrianthefs, MD, PhD, Athens University, Intensive Care Unit, Agioi Anargyroi Hospital, 14561, Nea Kifissia, Athens, Greece; e-mail: pmiriant@nurs.uoa.gr


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(4):926-927. doi:10.1378/chest.13-2978
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To the Editor:

We read with great interest the article by Tumbarello et al1 in a recent issue of CHEST (December 2013). The authors demonstrated that in critically ill patients with ventilator-associated pneumonia (VAP) caused by colistin-only susceptible gram-negative bacteria, aerosolized (AS) plus IV (AS + IV) colistin (as compared with IV colistin alone) can significantly improve clinical cure rates (69.2% vs 54.8%, P = .03) and reduce the need for mechanical ventilation (MV) after VAP onset (8 days vs 12 days, P = .001). Also, patients in the AS + IV group had 2 fewer ICU days after VAP onset (median, 12 days vs 14 days), 1.5 fewer days total ICU stay (median, 24.5 days vs 26 days), and 3 days shorter duration of colistin treatment (median 7 days vs 10 days) compared with the IV group.

However, nothing is recommended regarding the possible cost benefits as a result of these findings. For example, in Greece, IV colistin formulations (each vial contains 75 mg of colistin messilate sodium, equal to 1 million International Units) cost €5.92 per vial; AS colistin formulations cost €2.93 per vial. Considering that the usual dose for IV therapy is 3 million International Units tid, and 1 million International Units tid for AS colistin as in the article by Tumbarello et al,1 we found that for a 10-day course of IV colistin monotherapy, the costs are €532.8, whereas for a 7-day combination of AS + IV therapy, the costs are €435.183. Thus, 7-day AS + IV therapy is less expensive as compared with 10-day IV monotherapy by €97.617 per patient. Also, median total variable daily ICU costs in our ICU are €573.18; the costs for intubated patients are €562.3 and €386.3 for nonintubated patients (data not published). Thus, a considerable cost benefit may occur as a result of fewer days under MV and shorter length of ICU stay.

Taking all factors into account, the use of AS + IV colistin therapy may be a cost-effective strategy in patients with VAP in terms of shorter duration of therapy, fewer days under MV, and shorter ICU stay in addition to significantly better clinical outcomes. These observations are of significant interest in terms of cost-effectiveness of AS + IV colistin therapy for the management of gram-negative bacteria VAP, which should be further investigated in large, multicenter, randomized controlled trials.

References

Tumbarello M, De Pascale G, Trecarichi EM, et al. Effect of aerosolized colistin as adjunctive treatment on the outcomes of microbiologically documented ventilator-associated pneumonia caused by colistin-only susceptible gram-negative bacteria. Chest. 2013;144(6):1768-1775. [CrossRef]
 

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References

Tumbarello M, De Pascale G, Trecarichi EM, et al. Effect of aerosolized colistin as adjunctive treatment on the outcomes of microbiologically documented ventilator-associated pneumonia caused by colistin-only susceptible gram-negative bacteria. Chest. 2013;144(6):1768-1775. [CrossRef]
 
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